Why Do We Need To "Recontrol" Whooping Cough?

The word is going out that a lot of people need to get a pertussis booster shot Pertussis, more commonly known as whooping cough, is a bacterial infection that is very dangerous and sometimes fatal in young infants, whose immune systems are too immature to protect them. The only way to protect the very young is to make sure those around them -- parents, siblings, other relatives, and day care providers -- are vaccinated. Many adults were vaccinated as children, but the vaccine's protection wanes after about ten years, so they still need a booster shot if they are caring for children.

What's new here? First, there's a new report from an expert advisory panel to the Centers for Disease Control. The CDC panel is urging doctors to vaccinate everyone who might be in contact with young children, even if they can't remember when or if they had the pertussis vaccine. A report in the Journal of the American Medical Association this past week quotes pertussis expert Michael Brady, M.D., who chairs the American Academy of Pediatrics committee on infectious diseases, who says the new recommendations are needed as part of our efforts at "recontrolling pertussis."

What does Dr. Brady mean when he says "recontrolling"?Well, whooping cough is not under control right now.In California, a serious epidemic continues.(See my previous post about it here.) The CDC reports over 7,800 cases of pertussis throughout California, including the deaths of 10 infants.These infants were too young to be vaccinated, and their deaths are a tragedy that could have been prevented.The last time we saw this many cases of whooping cough in California was 63 years ago, in 1947.

Meanwhile, Michigan continues to have its own pertussis outbreak, with 1,092 cases this year, and 902 cases last year. And the pertussis epidemic has spread to Ohio, where two counties collectively report 910 cases this year, the largest number in 25 years.

In infants and very young children, pertussis causes violent, spasmodic coughing that repeats over and over. The cough is so strong that babies cannot breath properly, and after multiple coughs they will breathe in sharply with a classic "whooping" sound, which gives the disease its name. Pertussis is far more dangerous in infants than in adults: from 2000-2004, 92% of the pertussis deaths in the U.S. were in children less than one year old.

Whooping cough used to be under control.The number of nationwide cases was dropping for years, and although the disease didn't disappear, we were getting to the point where most people didn't know anyone who'd had it.The question is, why did we lose control?Is a new strain of pertussis to blame?Or is it our own behavior?

Unfortunately, the answer seems to be that these outbreaks are spreading as a result of falling vaccine rates, for which we can thank the anti-vaccine movement, which has been very effective at getting their message out through mainsteam media, including the Larry King show, Oprah, and The Huffington Post. One of the main groups in this movement is the misnamed National Vaccine Information Center, which really should be called the Vaccine Misinformation Center. Its pertussis web page contains a section titled "Can pertussis vaccine cause brain damage and death?" The mere act of asking this loaded question may cause people worry. And rather than answering "no," the website goes on for several paragraphs, selectively quoting from studies that looked at vaccine risks - which are very small, but not zero - while ignoring the much greater risks of the disease itself. NVIC's website concludes by claiming (without citation) that:

"Most pediatric neurologists acknowledge that vaccination, including use of vaccines for smallpox, rabies, influenza, mumps, measles, tetanus, polio and pertussis, can and does occasionally cause neurological complications that can lead to permanent brain dysfunction."

Scare tactics indeed.Not only is NVIC trying to scare parents away from the pertussis vaccine, but the group takes the opportunity to warn against many other vaccines.NVIC claims on its website that it "does not promote the use of vaccines and does not advise against the use of vaccines." This is misleading. Its primary mission is anti-vaccine advocacy, as illustrated by its current advertising campaign that claims we are "over-vaccinating" children and injecting them with harmful toxins.

So we can thank NVIC and other anti-vaccine groups, such as Generation Rescue (which claims, among many other mistaken notions, that the pertussis vaccine causes autism), for the re-emergence of whooping cough.

"Results from clinical trials showed that these vaccines are very safe for infants and children....The most common adverse events reported have been tenderness and redness where the shot was given, headache, diarrhea, and fussiness."

(The current vaccine against whooping cough is called DTaP or TDaP, which is short for "tetanus toxoid, reduced diphtheria toxoid and acellular pertussis", and the evidence shows that it is very safe. The vaccine does not contain any whole cell, not even killed bacteria, meaning that it is impossible for the vaccine to cause even a mild case of any of the diseases that it protects against.)

The CDC advisory on the pertussis vaccine is not part of a conspiracy to "over-vaccinate" the public, or to pad the profits of Big Pharma. (By the way, to pre-empt some of the commenters: I am not paid a single penny by any pharmaceutical company, nor am I paid by Forbes.) The advisory is a necessary step to "recontrol" whooping cough, a disease that we should not have let back into our communities. I fear that if we keep listening to the anti-vaccine activists, pertussis will be just the first in a series of diseases that will return to plague us, causing needless suffering and anguish.

I'm the Bloomberg Distinguished Professor of Biomedical Engineering, Computer Science, and Biostatistics at Johns Hopkins University. From 2005-2011 I was the Horvitz Professor of Computer Science and Director of the Center for Bioinformatics and Computational Biology at the...